Provider Demographics
NPI:1992793533
Name:LEONARD, JAMES SAMUEL (DPM)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:SAMUEL
Last Name:LEONARD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:1095 COMMONS AVE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1669
Practice Address - Country:US
Practice Address - Phone:607-756-5422
Practice Address - Fax:607-756-5488
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004037-1213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00989262Medicaid
NY0005567056OtherAETNA PIN
NY040426013555OtherFIDELISCARE NY
11123258OtherCAQH
NYUNIVERA HEALTHCARE COther00040115201
NY043587567OtherEXCELLUS BLUE SHIELD CNY
480033278OtherRAILROAD MEDICARE
NY043587567001OtherRMSCO INC
480033278OtherRAILROAD MEDICARE
NYDD0251Medicare PIN
NYUNIVERA HEALTHCARE COther00040115201